Health Declaration Forms

Sample template: self declaration health form

Time to complete

1 minute

Eligibility

There are no such eligibility criteria, any individual can fill out the form.

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Questions for Health Declaration Forms

1.

Do you have any allergies?

The answer should be a single choice:
  1. Yes
  2. No
2.

Do you have any medical conditions that require immediate attention?

The answer should be a single choice:
  1. Yes
  2. No
3.

Have you ever had an allergic reaction to a vaccine?

The answer should be a single choice:
  1. Yes
  2. No
4.

Do you have any chronic conditions? If so, please briefly describe below.

The answer should be a single choice:
  1. Yes
  2. No
5.

Are there any changes that should be made for future vaccines or treatments?

The answer should be a single choice:
  1. Yes
  2. No
6.

Have you ever had any adverse reactions to medications or treatments? If so, please briefly describe below.

The answer should be a text input.
7.

Do you have a current prescription for any medication?

The answer should be a single choice:
  1. Yes
  2. No
8.

If yes, please list the name of each medication:

The answer should be a text input.
9.

Are there any changes that should be made for future vaccines or treatments?

The answer should be a single choice:
  1. Yes
  2. No

Similar Ideas

  • Health Declaration Form for Travelers
  • Health Declaration Form for Pregnant Women
  • Health Declaration Form for Children
  • Health Declaration Form for the Elderly
  • Health Declaration Form for Persons with Disabilities

Here are some FAQs and additional information
on
Health Declaration Forms

What are Declaration Forms?

Declaration Forms are documents that are required to be completed by individuals seeking to enter into the United Arab Emirates. The forms request personal information such as name, contact details, and travel history. They also require individuals to declare any health conditions that they may have.

Who needs to complete Declaration Forms?

All individuals seeking to enter the United Arab Emirates are required to complete Declaration Forms. This includes both tourists and residents.

What information is required on Declaration Forms?

Declaration Forms request basic personal information such as name, contact details, and travel history. They also require individuals to declare any health conditions that they may have.

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